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Aim: The aim of this review is to determine the current standard treatment modality via comparing oncological and functional outcomes of treatment options under current literature in patients with low-intermediate risk prostate cancer. New Findings: In 2011, in United States, 240.890 new prostate cancer cases was detected and 90% of these cases were at the stage of localized disease. Treatment alternatives for low-intermediate risk prostate cancer involves active suveillance, radical surgical treatments, radiotherapy, focal ablative treatments, and experimental treatment modalities. While making decision about the optimum treatment modality, patient's lif expectancy, comorbidity, tumor biology, risks and complications of the treatment modality and clinically insignificant disease should be considered. Results: Because of the lack of clearness about the indication criteria, needing intensive follow-up and the absence of randomised controlled trials which have long term results, active surveillance could not become a standard treatment modality currently. The oncological outcomes of radical prostatectomy are superior and the morbidity is similar to radiotherapy, so that, in 2013, radical prostatectomy is the standard treatment modality in patients with low-intermediate risk prostate cancer.

Prostate-specific antigen screening has led to a dramatically increased detection of small-volume, low grade and organ-confined prostate cancer. In an era where active surveillance is now considered a feasible alternative for low-risk prostate cancer patients, it is possible that organ-sparing treatments like focal treatments options (HIFU, CSAP vs.) could also be good treatment alternatives in selected patient groups. Focal therapy is an appealing strategy for any tumor and in time may prove to be a valuable treatment option for low-risk, carefully selected prostate cancer patients. The aim of focal therapy is to achieve long-term cancer control with minimal morbidity yet without the side effects of radical therapy. Appropriate selection techniques for focal therapy are developing. Diagnostic methods for focal therapy like extensive mapping prostate biopsies, imaging techniques, and biomarkers are obligatory to improve the efficacy of focal therapy. Limitations of focal therapy consist of the incapability to stage or grade the prostate cancer accurately, suboptimal diagnostic methods, uncertainty regarding the natural history of untreated cancer foci, difficulties in follow-up and the lack of comparison with other treatment strategies. Early experiences of focal therapy evaluating a variety of modalities are encouraging but hampered by study design limitations and small sample sizes. Focal therapy is an encouraging treatment alternative and in time may be proven to be a valuable treatment option for low-risk, carefully selected prostate cancer patients. Prospective clinical trials had to be done before the strategy of focal treatment is accepted in clinical practice.